How Sick Is Modern Medicine?

1.

As Marcus Aurelius gathered his forces against German tribes in the second century AD, he summoned Claudius Galenus, an up-and-coming physician from Pergamum, to ride with him. Galen declined, politely and imaginatively, claiming a higher loyalty to “the contrary instructions of his personal patron god Asclepius.”1 This early instance of conscientious objection was accepted, it seems graciously. But in exchange for his indulgence, Marcus Aurelius ordered Galen to await his return and attend the health of his neophyte emperor son, the soon to be deranged Commodus.

Galen did his job rather too well, curing Commodus of an illness around 174 AD and unwittingly laying the ground for a murderous period of political instability some ten years or so later. Rome’s long-term loss was medicine’s great gain, for, as Galen later wrote,

During this time I collected and brought into a coherent shape all that I had learned from my teachers or discovered for myself. I was still engaged in research on some topics, and I wrote a lot in connection with these researches, training myself in the solution of all sorts of medical and philosophical problems.

In addition to being a fine scholar and a wise court physician, Galen was also the supreme polemicist of his day. The aggressive tendencies of his mother—“so bad-tempered that she would sometimes bite her maids”—provided a valuable store of endurance for Galen to draw on as he quarreled with his contemporaries. Indeed, his passion for conflict led him, at the age of twenty-eight, into the unusual role of physician to the gladiatorial school of Pergamum, a position, amid the flayed limbs, punctured chests, and eviscerated abdomens, that gave him a perfect vantage point for firsthand anatomical observation.

One of Galen’s philosophical preoccupations was to understand how doctors came to know what they did about healing. He lived at a time when there was no consensus about how doctors should acquire knowledge. Empiricists relied entirely on experience, while Rationalists depended on reason from a prespecified theory of causation. A third group, the Methodists, rejected both experience and causal theory, putting all illnesses down to a tension between the flow of bodily discharges and their constipation. Galen was a deft eclectic. He scrutinized opposing arguments, identified their flaws, erased erroneous logic, and combined what remained into a practicable clinical method. He wished to assert the primacy of clinical observation and to bind an integrated (Hippocratic, Platonic, Alexandrian) theory of medical knowledge with its practice. But Galen wanted to achieve his unique synthesis neither as a remote theoretician nor as someone who had a reputation for being merely a “word doctor”: “Rather, my practice of the art alone would suffice to indicate the level of my understanding.”

In The Rise and Fall of Modern Medicine James Le Fanu, a practicing London doctor, a prominent medical controversialist in the English press, and a person wholly dissatisfied with the huge power exerted by modern medical sects, has surveyed and systematized, processed and picked apart the…


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